Emergency department profits are likely to continue as the affordable care act expands coverage

Health Affairs

Volumn 34, Issue 5, 2014, Pages 792-799

  Wilson, Michael ^a   Cutler, David ^b  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b NATIONAL BUREAU OF ECONOMIC RESEARCH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; EMERGENCY WARD; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH SERVICE; HUMAN; MEDICAID; MEDICARE; PRIVATE HEALTH INSURANCE; PROFIT; REIMBURSEMENT; COST BENEFIT ANALYSIS; ECONOMICS; EMERGENCY HEALTH SERVICE; HEALTH ECONOMICS; HOSPITAL CHARGE; HOSPITAL COST; STATISTICS AND NUMERICAL DATA; UNITED STATES;

COST-BENEFIT ANALYSIS; ECONOMICS, HOSPITAL; EMERGENCY SERVICE, HOSPITAL; HEALTH CARE REFORM; HOSPITAL CHARGES; HOSPITAL COSTS; HUMANS; PATIENT PROTECTION AND AFFORDABLE CARE ACT; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 84899842456     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2013.0754     Document Type: Article

References (29)

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15. The Nationwide Emergency Department Sample (NEDS) is a nationally representative database of ED visits constructed using state inpatient and emergency department databases by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.
16. Medicare health maintenance organization (HMO) visits are reimbursed at a higher rate. However, these patients present with less severe medical conditions on average. We assume that hospital revenue from Medicare HMO patients was similar to revenue from fee-forservice Medicare visits.
17. We weighted to the national level because the Truven Health Market-Scan Commercial Claims and Encounters Database we used does not have geographic identifiers. The database information is from 2009.
18. We weighted to the region level because the NEDS contains only regional identifiers. The weight is based on each state's total number of Medicaid beneficiaries, as obtained from Kaiser Commission on Medicaid and the Uninsured. Medicaid, a primer, 2013: key information on the nation's health coverage program for low-income people [Internet]. Washington (DC): Kaiser Family Foundation; 2013 Mar. Table 1: Medicaid enrollment by group, FY 2009 [cited 2014 Mar 28]. Available from: http://kaiserfamilyfoundation.files.wordpress.com/2010/06/7334-05.pdf
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27. To access the Appendix, click on the Appendix link in the box to the right of the article online.
28. Our finding of underpayment from Medicare is consistent with what is reported from the Medicare Payment Advisory Commission. Hospitals in 2010 had overall negative Medicare margins of -4.5 percent. We found ED margins to be more negative, at -13.5 percent. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): Med-PAC; 2013 Mar [cited 2013 Aug 21]. Available from: http://www.medpac.gov/documents/Mar13_entirereport.pdf
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